Rcg Franklin

“POC-MANAGE VOLUME STATUS CFR(s): 494.90(a)(1) The plan of care must address, but not be limited to, the following: (1) Dose of dialysis. The interdisciplinary team must provide the necessary care and services to manage the patient’s volume status; This Standard is not met as evidenced by: 33763 Based on facility policy review, medical record review and interview, the facility failed to ensure patients were monitored during hemodialysis treatment per facility policy for 3 of 4 (Patient #1, #2, and #6) sampled incenter hemodialysis patients. The findings included: 1. Review of the facility’s “Monitoring and safety Checks During Hemodialysis Treatment” policy dated 9/5/2024 revealed, “...Patient monitoring and safety check guidelines...Monitor and document every 30 minutes or more frequently as needed but not to exceed 45 minutes...Patient Monitoring includes...Blood pressure, pulse, respirations...” 2. Medical record review revealed Patient #1 was admitted to the facility on 7/9/2025 with diagnoses which included Hypertensive Chronic Kidney Disease and ESRD. The physician’s orders dated 7/30/2025 revealed the Patient was to receive hemodialysis treatments 3 times a week via a CVC. Review of the hemodialysis Treatment Sheet dated 7/30/2025 revealed the facility failed to assess the Patient’s blood pressure and pulse rate during hemodialysis from 10:00 AM until 10:56 AM, a total of 56 minutes. 3. Medical record review revealed Patient #2 was admitted to the facility on 8/5/2024 with diagnoses which included Hypertensive Chronic Kidney Disease and ESRD. The physician’s orders dated 7/28/2025 revealed the Patient was to receive hemodialysis treatments 3 times a week via an AVF. Review of the hemodialysis Treatment Sheet dated 7/30/2025 revealed the facility failed to assess the Patient’s blood pressure and pulse rate during hemodialysis from 8:38 AM until 9:38 AM, a total of 60 minutes (1 hour) and from 9:38 AM until and 10:26 AM, a total of 48 minutes. Review of the hemodialysis Treatment Sheet dated 8/20/2025 revealed the facility failed to assess the Patient’s blood pressure and pulse rate during hemodialysis from 7:02 AM until 8:03 AM, a total of 61 minutes (1 hour and 1 minute). 4. Medical record review revealed Patient #6 was admitted to the facility on 6/20/2025 with diagnoses which included Acute Kidney Failure. The physician’s orders dated 7/4/2025 revealed the Patient was to receive hemodialysis treatments 3 times a week via a CVC. Review of the hemodialysis Treatment Sheet dated 8/1/2025 revealed the facility failed to assess the Patient’s blood pressure and pulse rate during hemodialysis from 8:34 AM until 9:38 AM, a total of 64 minutes (1 hour and 4 minutes). Review of the hemodialysis Treatment Sheet dated 8/22/2025 revealed the facility failed to assess the Patient’s blood pressure and pulse rate during hemodialysis from 7:32 AM until 8:33 AM, a total of 61 minutes (1 hour and 1 minute) and from 8:33 AM until 9:33 AM, a total of 60 minutes (1 hour). 5. During an interview on 8/26/2025 at 2:20 PM, CM #1 stated patient’s vital signs should be assessed every 30 minutes, but not to exceed 45 minutes during hemodialysis treatment.”

“POC-ACHIEVE ADEQUATE CLEARANCE CFR(s): 494.90(a)(1) Achieve and sustain the prescribed dose of dialysis to meet a hemodialysis Kt/V of at least 1.2 and a peritoneal dialysis weekly Kt/V of at least 1.7 or meet an alternative equivalent professionally-accepted clinical practice standard for adequacy of dialysis. This Standard is not met as evidenced by: 33763 Based on facility policy review, medical record review and interview, the facility failed to ensure physician’s orders for BFR were followed for 3 of 4 (Patient #1, #2, #3, and #6) sampled incenter hemodialysis patients. The findings included: 1. Review of the facility’s “Patient Assessment and Monitoring” policy dated 5/1/2023 revealed, “...Check machine settings and measurements...Check prescribed blood flow is being achieved or reason is documented in medical record if unable to meet prescribed blood flow...” 2. Medical record review for Patient #1 revealed an admission date of 7/9/2025 with diagnoses which included Hypertensive Chronic Kidney Disease and ESRD. The physician’s orders dated 7/28/2025, 7/30/2025, 8/4/2025 and 8/8/2025 revealed a BFR of 350. Review of the hemodialysis Treatment Sheet dated 8/1/2025 revealed the BFR was 300 from 9:36 AM to 11:05 AM. There was no documentation why the BFR was not delivered at the ordered rate of 350. There was no documentation the physician was notified. Review of the hemodialysis Treatment Sheet dated 8/4/2025 revealed the BFR was 300 from 8:12 AM to 11:04 AM. There was no documentation why the BFR was not delivered at the ordered rate of 350. There was no documentation the physician was notified. Review of the hemodialysis Treatment Sheet dated 8/8/2025 revealed the BFR was 300 from 10:04 AM to 11:07 AM. There was no documentation why the BFR was not delivered at the ordered rate of 350. There was no documentation the physician was notified. 3. Medical record review for Patient #2 revealed an admission date of 8/5/2025 with diagnoses which included Hypertensive Chronic Kidney Disease and ESRD. A physician’s order dated 7/28/2025 revealed a BFR of 450. Review of the hemodialysis Treatment Sheet dated 8/20/2025 revealed the BFR was 400 from 6:34 AM to 10:10 AM. There was no documentation why the BFR was not delivered at the ordered rate of 450. There was no documentation the physician was notified. 4. Medical record review for Patient #3 revealed an admission date of 1/28/2016 with diagnoses which included Type 2 Diabetes Mellitus and ESRD. The physician’s orders dated 6/27/2025 and 8/1/2025 revealed a BFR of 450. Review of the hemodialysis Treatment Sheet dated 7/30/2025 revealed the BFR was 300 from 12:37 PM until 2:06 PM. There was no documentation why the BFR was not delivered at the ordered rate of 450. There was no documentation the physician was notified. Review of the hemodialysis Treatment Sheet dated 8/6/2025 revealed the BFR was 300 from 1:33 PM until 3:01 PM. There was no documentation why the BFR was not delivered at the ordered rate of 450. There was no documentation the physician was notified. Review of the hemodialysis Treatment Sheet dated 8/8/2025 revealed the BFR was 350 from 12:35 PM until 2:11 PM. There was no documentation why the BFR was not delivered at the ordered rate of 450. There was no documentation the physician was notified. Review of the hemodialysis Treatment Sheet dated 8/15/2025 revealed the BFR was 350 from 12:11 PM until 1:02 PM. There was no documentation why the BFR was not delivered at the ordered rate of 450. There was no documentation the physician was notified. Review of the hemodialysis Treatment Sheet dated 8/20/2025 revealed the BFR was 350 from 12:42 PM until 4:07 PM. There was no documentation why the BFR was not delivered at the ordered rate of 450. There was no documentation the physician was notified. During an interview on 8/26/2025 at 2:45 PM, CM #2 stated Patient #3’s AVF clotted, and a new CVC was placed while he was hospitalized on 7/28/2025. The CM continued and stated the facility failed to obtain new physician’s orders to reflect the Patient’s CVC access and updated BFR of 350. 5. Medical record review for Patient #6 revealed an admission date of 6/20/2025 with diagnosis of Acute Kidney Failure. A physician’s order dated 7/4/2025 revealed a BFR of 350. Review of the hemodialysis Treatment Sheet dated 8/11/2025 revealed the BFR was 300 from 7:03 AM to 10:02 AM. There was no documentation why the BFR was not delivered at the ordered rate of 350. There was no documentation the physician was notified. 6. During an interview on 8/26/2025 at 2:45 PM, CM #2 verified anytime staff were unable to reach the ordered BFR the reason should be documented.”